Cosmetic Surgeries Get a Little Nip and Tuck

Thursday

Apr 29, 2010 at 5:11 AM

The five most popular procedures fell in number by nearly 9 percent in 2009, a survey of plastic surgeons, dermatologists and doctors shows.

CATHERINE SAINT LOUIS

COSMETIC surgery wasn’t as popular in 2009 as it used to be, according to the American Society of Plastic Surgeons, which annually surveys its members as well as dermatologists and ear-nose-and-throat doctors.

Such procedures, including nose jobs, eyelid surgeries, liposuction, tummy tucks and breast augmentations, fell in number by nearly 9 percent in 2009, the society reported Tuesday, to 1,521,409 from 1,669,026 in 2008. Nose jobs and eyelid surgery fell 8 percent among the 715 doctors who answered the survey, while liposuction was down a whopping 19 percent. Tummy tucks and breast augmentations declined 5 percent and 6 percent, respectively.

Pocketbook issues may be the story behind the numbers — an operation like a tummy tuck costs on average $4,936, excluding the thousands of dollars in anesthesia and operating-room fees. But perhaps Americans also started to make the best of their looks, investing in wardrobe enhancement instead of, say, liposuction.

“Cosmetic surgery is a luxury item,” said Dr. Michael F. McGuire, the president of the American Society of Plastic Surgeons, who practices in Los Angeles. “People are thinking twice about spending money, even if they have it. I’ve noticed even very wealthy patients, they are deferring.”

Dr. McGuire thinks that those deferrers will eventually have the surgery they desire. “People are putting it off, but if you’ve been unhappy about something, you will get it fixed,” he said.

Although the numbers provided by the American Society of Plastic Surgeons offer a valuable snapshot, they are by no means definitive. The doctors who answer one year’s survey might not answer the next year’s. And the figures don’t include doctors who perform cosmetic procedures and who trained in, say, obstetrics-gynecology or family medicine.

The declines reported in this survey echoed the findings of another recent survey by the American Society for Aesthetic Plastic Surgery, which found an even steeper decline in cosmetic-surgery procedures performed last year — 18 percent.

Yet some doctors express confidence that there is pent-up demand. Dr. Robert Singer, a plastic surgeon in San Diego, said that people have been trying less-expensive alternatives to the procedures they want.

For instance, some patients have “opted to have fillers or Botox because they felt — and it was marketed to them — it would be in lieu of a face-lift,” Dr. Singer said. But “it didn’t give the result they wanted.”

Other patients “got a reasonable result” by being injected with a mix of Botox and fillers, said Dr. Singer, a former president of the American Society for Aesthetic Plastic Surgery. But that result is temporary, and some of those patients now want a longer-lasting surgical improvement for their face, he said.

Recently, Realself.com, a Web site where patients discuss cosmetic procedures, did a survey with Harris Interactive to get a sense of how many consumers there are with aesthetic dreams deferred. In an idealized world in which we all have enough money, they asked, how many of us would choose cosmetic alterations? Sixty-nine percent of the nationwide sample of 2,148 adults who were asked in March said that they would choose to have cosmetic work, up from 54 percent who said the same thing in November 2009.

Tom Seery, the president and founder of Realself.com, said in an interview that the site’s traffic was growing and that visitors displayed “strength and interest around cosmetic surgery on the invasive side.”

Surprisingly, for the first time, the doctors surveyed by the American Society of Plastic Surgeons reported that the number of wrinkle-freezing botulinum toxin injections administered declined by 4 percent. Last year, the Food and Drug Administration approved Dysport for smoothing the between-eyebrows wrinkles, clearing the way for it to give Botox a run for its market share. But it seems that Dysport arrived just as Americans decided not to get as many botulinum toxin injections for aesthetic concerns, perhaps a sign of a fatigue among people who got routine injections for upkeep.

“If you’ve been having it for several years every couple of months, first of all, you’ve spent a lot of money,” said Dr. McGuire, who injects Botox and Dysport. “It adds up, and it hurts each time you have it.” Still, a staggeringly large number of doses of Botox or Dysport were injected in 2009: 4,795,357, at $405 each on average. Such injections remain the top minimally invasive cosmetic procedure.

A few obscure cosmetic operations increased in 2009, despite their not-insignificant cost. There was a slight uptick in calf augmentation, which entails using a silicone implant to enhance calves, up to 259, from 247. Surgically pumping up calves isn’t cheap — $3,649 on average — but apparently ballet dancers and bodybuilders find them worthwhile. “To be a success as a ballet dancer, it’s about as much your appearance as your ability to dance,” Dr. McGuire said. “You may have good muscle, but it doesn’t have shape and appearance that’s considered optimal.”

Lip augmentations using a physical implant, which cost on average $1,736, are also on the rise. More than 21,000 people got their lips filled out this way as opposed to, say, periodically having their lips injected with a filler. The uptick is particularly noteworthy considering that no lasting lip implant is approved for that purpose by the Food and Drug Administration, which means that this use cannot be marketed by companies. Rather, doctors can choose to use an implant approved for another part of the face.

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